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In Vivo Endothelial Cell Density Decline in the Early Postoperative Phase After Descemet Membrane Endothelial Keratoplasty

Miron, Alina PDeng*,†,‡; Bruinsma, Marieke PhD*,†; Ham, Lisanne PhD*,†,‡; Schaal, Sontje-Chiao MD*; Baydoun, Lamis MD*,†; Dapena, Isabel MD, PhD*,†; Oellerich, Silke PhD*; Melles, Gerrit R. J. MD, PhD*,†,‡

doi: 10.1097/ICO.0000000000001484
Clinical Science

Purpose: To evaluate endothelial cell density (ECD) in the first 6 months after Descemet membrane endothelial keratoplasty (DMEK) by eliminating method error as a confounding variable.

Methods: From 24 DMEK eyes operated for Fuchs endothelial corneal dystrophy, from which specular microscopy images could be taken at 1 day and 6 months postoperatively, ECD values were compared between these 2 time points.

Results: Using the 1-day ECD measurement as baseline, mean ECD decreased from 1913 (±326) cells/mm2 to 1524 (±393) cells/mm2 at 6 months, a decline of −18 (±19)%. With the 1-week ECD as baseline [1658 (±395) cells/mm2], the decline at 6 months was −6 (±19)% and when using preoperative ECD as baseline [2521 (±122) cells/mm2], the decline was −39 (±16)% at 6 months.

Conclusions: After DMEK, ECD shows an in vivo decline of 18% from 1 day to 6 months postoperatively, with a sharp 13% drop in the first week, and a slower decrease thereafter. The remaining difference of 20% from preoperative ECD values may be attributed to a measurement error in the eye bank with an overestimation of the graft's viable endothelial cell population and/or intraoperative trauma to the graft.

*Netherlands Institute for Innovative Ocular Surgery, Rotterdam, The Netherlands;

Melles Cornea Clinic Rotterdam, Rotterdam, The Netherlands; and

Amnitrans EyeBank Rotterdam, Rotterdam, The Netherlands.

Correspondence: Gerrit R. J. Melles, MD, PhD, Netherlands Institute for Innovative Ocular Surgery, Laan op Zuid 88, 3071AA Rotterdam, The Netherlands (e-mail:

G. R. J. Melles is a consultant for DORC International/Dutch Ophthalmic USA and SurgiCube International. L. Baydoun and I. Dapena are consultants for DORC International/Dutch Ophthalmic USA. The other authors have no funding or conflicts of interest to disclose.

Received October 11, 2017

Received in revised form October 25, 2017

Accepted October 25, 2017

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